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The Prime Minister, David Cameron has written to the Department of Health asking them to investigate how the money

David Cameron has been talking about establishing a right to respite for carers

committed to providing breaks for carers is being allocated and used by Primary Care Trusts. He has advised that this is an “issue of personal importance to me” and that “we must support carers who do the most valuable work often at great personal cost to themselves. We must ensure that carers are provided with the support they need.”

Cameron’s intervention came about after a letter from Theresa Villiers MP, who attended our Give Carers a Break campaign launch earlier this year. It also comes after previous Department of Health action on this issue and we await the Department of Health’s response to this request.

Previously, the Department of Health did act after our report detailed the failure of PCTs to develop plans and budgets to support carers with local carers’ charities, as Government requested. They requested that all PCTs advise by 2nd September if they had published plans and budgets to support carers. It was expected that PCTs missed this date only in exceptional circumstances.

Government is now clarifying some of the information returned, and we have also started our review of whether PCTs have published plans and budgets and how much is being allocated.

Government have also said that they will release guidance next month giving clear expectations of how Primary Care Trusts (and Clinical Commissioning Groups, successors to PCTs) should support carers in the next financial year 2012/13.

At the same meeting with charities and the Department of Health that I talked about in my last blog, we also discussed the regulation of care providers and personal assistants. Currently in England, if a person hires an individual who is not employed by any agency, charity, council or company to provide care, then that person – a personal assistant – does not have to be registered with the Care Quality Commission (CQC). This can be if the person is using their own money or a council funded personal budget or direct payment.

Some people were in favour of this as individuals should be able to employ whoever – friends, non co-resident relatives, neighbours etc – they want without that person having to go through the lengthy and expensive registration process. It may be that this is the right choice for the family and provides the most appropriate care.

However, there were other people horrified at the risks involved in this. What if the budget holder doesn’t employ a friend or relative but sees an ad in the local paper and hires a perfect stranger who doesn’t have to be registered or go through regulatory checks? You could be increasing the opportunity for vulnerable people to be taken advantage of.

And what if this stranger was actually being hired by numerous people and it was like a full-time job for them? There could be multiple opportunities for abuse.

The key phrase here is “vulnerable people” meaning people who may not have the capability to make safe choices for themselves. In response, some will ask what gives us the right to decide who has the ability to make safe choices or not? We should not assume that people with disabilities cannot make informed, sensible decisions in their own best interests.

My view is this. Individuals should be able to hire whoever they want – friends, relatives, neighbours, strangers even if they are not registered with the CQC. However, there is a risk that people may make unwise choices (even those who we don’t consider ‘vulnerable’ may do so). What mitigates this risk is information.

If we think there is a danger that they might make unsafe choices, then let’s help them understand the choices they have and decrease the chance of them making poor decisions that could lead to abuse. People should have access to brokerage and support services that know the local area, people and providers and can help individuals find the people and services they want. And part of this may be advising them who is and who is not registered with the CQC.

This won’t mean that nobody will ever make a bad or unsafe choice that will lead to them suffering harm. Unfortunately, no matter the system, abuse will always happen. It happens now even with people who work for registered care providers.

The “Out of Hospital” project included partnership work between carers, Carers’ Centres and hospitals in Barnet and in Swindon. This afternoon carers, carers’ workers and NHS workers from Swindon and Barnet will be at the launch to share the practical tips that they found worked to get everyone acting together to benefit patients and carers and avoid readmissions to hospital.

I’m hoping the launch will inspire those NHS workers who attend to develop their partnership with carers and in turn help them in changing hospital systems and culture. We’ve already received messages of support from the Royal College of GPs and other NHS bodies so that’s a really positive start.

Have a look at the key messages from the report and it would be great if you could share them with other carers, carers’ workers and NHS planners and staff that you know.

I will be back soon to let you know how the launch went, including what the carer presenting at the launch had to say.

As you may have read in an earlier blog, my boss, Alex Fox is leaving after 10 years of working for carers. In his blog he recounts the progress made in terms of recognition and understanding carers’ issues. What he missed out was the role that he played in bringing this about. Make no doubt about it, there are carers and families who will never know, meet or even hear of him, but there will be many whose lives have been improved because of him.

Individuals can and do make a difference. There are still many issues facing carers and there are still many carers struggling without any help whatsoever but there are also some whose lives have been improved because others have taken action.

For a few years now we’ve been working with the Royal College of GPs (RCGP) to increase GP awareness of carers’ issues. It’s obvious that not every GP in the UK fully understands how they can help carers, but we have been receiving examples of huge improvements. It is clear that some carers’ lives have been changed because a GP has stepped in to help.

To recognise this and to highlight to GPs who are maybe not fully engaged what can be achieved, we have launched a Caring about Carers award with the RCGP. This is a chance for carers and families who feel their GP has made a difference to recognise this and highlighting these successes will hopefully encourage others to try too.

A guest blogger! I’m Drew, The Trust’s lead on all things mental health related. I’m stepping in for Gordon this week because, well, we like to keep things fresh!

Gordon would like to have the excuse of being on an all-expenses paid trip to the Bahamas, but alas for him, he is doing his job as normal. I’m also here to give a flavour of some other work we do, which links up to Gordon’s sterling work lobbying our elected officials.

So, as always, there are a number of big Government initiatives and consultations going on. Alongside examples like the Big Care Debate, there are other key issues other colleagues and I lead on, often within specialist areas like young people, substance misuse, and of course mental health.

Specialist? Bunk! Bunk I say! Mental health is categorically not a specialist issue, as not only is mental health something we all have and must manage, but the majority of carers are likely to experience some impact on their mental wellbeing as a result of caring. Which is why I’ve focused my efforts on the Government’s new 10-year strategy for mental health in England, New Horizons.

We’ve submitted our response to the New Horizons consultation (read it here) which finished on the 15th October. This was based on what carers, our network of Carers’ Centres, and other partner organisations said they wanted to see. We’re promised the final strategy from the Government before Christmas.

So why is this relevant for all carers?

Firstly, the New Horizons consultation document sets out the vision for mental health service improvement in England, making it extremely relevant to carers of people with mental health problems. But the other, loftier goal is to improve ‘whole population mental health’; in short, more prevention as well as better treatment.

Essentially, the Government aims to raise awareness of mental and emotional wellbeing, why this is important, and help prevent people from becoming unwell in the first place. To do this, we’ll probably need health promotion campaigns on mental health that will stick in the public mind (like ‘5 fruit and veg a day’ has for diet), and lots more besides.

Given that carers as a group often want and require emotional support, as well as running higher risks of mental health problems, it’s vital to get New Horizons to respond to carers’ needs as a priority group.

We need New Horizons to support carers with their own mental health and emotional needs as much as improved services.

I share Gordon’s upbeat approach about the world. I like to pretend to be a cynic, but can’t keep it up; curse my natural optimism! But for New Horizons, my optimism about what the consultation document says is slightly dampened by my fears about what it’ll actually do.

Call me naïve, but I believe the Department of Health (who authored New Horizons) do want to improve things for mental health service users, carers and the wider public. It’s in no-one’s interests for things to get worse. I like New Horizons’ messages about carers, emphasising carers’ vital role in treatment and need for services to support them too.

But how is this going to happen? There’s no new money to support implementation of the Strategy. There are no set targets for changes to be made – understandable given increasing decentralisation of health and social care, but worrying for those who feel that benchmarks need to be set for goals to be met.

After reading the whole document (all 130 thrilling pages), I’m left with the sense that without explicit targets and monitoring for the Strategy’s goals (perhaps tied in the with new Care Quality Commission’s upcoming mental health strategy), we’ll be asking for the same things again in 2020. And with the spending cuts promised by mainstream political parties, this looks increasingly likely.

What can we do?

Keep the pressure up, and make it clear to our MPs and Government officials that carers and their mental health needs are not a specialist, or perish the thought, optional area of public expenditure.

Keep pushing how services could be improved, and offering examples of how this works well in some areas.

And finally, keep the argument fresh in our MPs’ minds, as we move towards election day, that without supporting carers and their own needs, it’s not just carers who suffer.

This is not a specialist concern – carers’ needs are especially important.